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How Does Marcaine (Bupivacaine) Work?

Marcaine is a brand name of bupivacaine, a longer-acting local anesthetic often used for comfort after surgery.

Same target, longer effect

Like lidocaine, bupivacaine blocks voltage-gated sodium channels in nerves. It binds more strongly and is more fat-soluble, so its numbing effect typically lasts several hours, considerably longer than plain lidocaine. It generally takes somewhat longer to start working.

How it is used

Surgeons often use a small, carefully measured amount near the end of an operation to extend comfort into the first hours of recovery, sometimes together with lidocaine, which acts sooner.

Safety

The main concern is accidental injection into a blood vessel or excessive total dose. Reviews of newer agents note that bupivacaine is associated with potentially serious heart toxicity, which led to development of related drugs such as levobupivacaine and ropivacaine. Because of this, dose limits are strict. Local anesthetic systemic toxicity is rare and treatable, and monitoring is part of how we manage it.

Tell your team about any past reactions to local anesthetics, heart rhythm problems or liver disease.

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References

  1. Shah J, Votta-Velis EG, Borgeat A. New local anesthetics. Best Pract Res Clin Anaesthesiol. 2018;32(2):179-185. PMID 30322458
  2. McClellan KJ, Spencer CM. Levobupivacaine. Drugs. 1998;56(3):355-362. PMID 9777312
  3. Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010;57(4):368-380. PMID 20151342